* Username
* Password
* Confirm Password
* Personal ID (Any 13 numbers but dont start it with ZERO.)
* Email Address (Make sure your email is valid, you cant change it later)
Refferal ID (Referral ID of the person who brought you in MUPH, it can be blank.)
* Enter the numbers you see in the secuirty code
Security Code
 
All Fields marked with * are required.